{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T07:18:47Z","timestamp":1769757527689,"version":"3.49.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"\n Importance<\/jats:title>\n Atrial fibrillation (AF) screening trials have failed to demonstrate a significant reduction in stroke risk. The impact on stroke severity and the importance of prior strokes are unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess stroke characteristics in patients undergoing implantable loop recorder (ILR) screening for AF vs usual care and assess the importance of prior stroke.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a post hoc analysis of the Atrial Fibrillation Detected by Continuous Electrocardiogram Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals (LOOP) randomized clinical trial. Persons 70 years or older without known AF but diagnosed with 1 or more of the following, hypertension, diabetes, heart failure, or prior stroke, were screened for inclusion. Four sites in Denmark recruited participants by letter between January 31, 2014, and May 17, 2016. The median (IQR) follow-up period was 65 (59-70) months. Data were analyzed from April 1 to May 31, 2022.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n ILR screening for AF and anticoagulation initiation if AF duration of 6 minutes or longer was detected (ILR group) vs usual care (control group).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Adjudicated stroke, classified according to the modified Rankin Scale (mRS) using a score of 3 or more as a cutoff for severe (disabling or lethal) stroke, and according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification for ischemic strokes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 6205 individuals were screened for inclusion, and 6004 were randomized and included in the analysis; 4503 participants (75%; mean [SD] age, 74.7 [4.1] years; 2375 male [52.7%]) were assigned to the control group and 1501 participants (25%; mean [SD] age, 74.7 [4.1] years; 792 male [52.8%]) were assigned to the ILR group. A total of 794 of 4503 participants (17.6%) in the control group had a history of prior stroke compared with 262 of 1501 participants (17.5%) in the ILR group. During follow-up, AF was diagnosed in 1027 participants (control group, 550 [12%] vs ILR group, 477 [32%]), and anticoagulation was initiated in 89% of these (910). A total of 315 participants (5.2%) had a stroke (control group, 249 [5.5%] vs ILR group, 66 [4.4%]), and the median (IQR) mRS score was 2 (1-3) with no difference across the groups. A total of 272 participants (4.5%) had ischemic stroke (control group, 217 [4.8%] vs ILR group, 55 [3.7%]), and 123 (2.0%) had severe stroke (control group, 100 [2.2%] vs ILR group, 23 [1.5%]), and the hazard ratios comparing the control and ILR groups were 0.76 (95% CI, 0.57-1.03;\n P<\/jats:italic>\n \u2009=\u2009.07) and 0.69 (95% CI, 0.44-1.09;\n P<\/jats:italic>\n \u2009=\u2009.11), respectively. For participants without prior stroke, the hazard ratios were 0.68 (95% CI, 0.48-0.97;\n P<\/jats:italic>\n \u2009=\u2009.04) and 0.54 (95% CI, 0.30-0.97;\n P<\/jats:italic>\n \u2009=\u2009.04), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This post hoc analysis of the LOOP randomized clinical trial found that ILR screening for AF did not result in a significant decrease in ischemic or severe strokes compared with usual care. Exploratory subgroup analyses indicated a possible reduction of these outcomes among participants without prior stroke.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02036450<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaneurol.2022.3031","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T08:30:31Z","timestamp":1661761831000},"page":"997","source":"Crossref","is-referenced-by-count":22,"title":["Severity and Etiology of Incident Stroke in Patients Screened for Atrial Fibrillation vs Usual Care and the Impact of Prior Stroke"],"prefix":"10.1001","volume":"79","author":[{"given":"S\u00f8ren Z\u00f6ga","family":"Diederichsen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian Steen","family":"Frederiksen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas Yixi","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketil J\u00f8rgen","family":"Haugan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren","family":"H\u00f8jberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Bispebjerg, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Brandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Internal Medicine\u2013Cardiology, University Hospital of Southern Denmark\u2013Esbjerg, Esbjerg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Graff","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten Salling","family":"Olesen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derk","family":"Krieger","sequence":"additional","affiliation":[{"name":"Stroke Unit, Mediclinic City Hospital, Dubai, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesper Hastrup","family":"Svendsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"7","key":"noi220057r1","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association.","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"issue":"8","key":"noi220057r2","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics 2022 update: a report from the American Heart Association.","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"issue":"26","key":"noi220057r3","doi-asserted-by":"publisher","first-page":"2478","DOI":"10.1056\/NEJMoa1313600","article-title":"Cryptogenic stroke and underlying atrial fibrillation.","volume":"370","author":"Sanna","year":"2014","journal-title":"N Engl J Med"},{"issue":"26","key":"noi220057r4","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1056\/NEJMoa1311376","article-title":"Atrial fibrillation in patients with cryptogenic stroke.","volume":"370","author":"Gladstone","year":"2014","journal-title":"N Engl J Med"},{"issue":"4","key":"noi220057r5","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/S1474-4422(17)30002-9","article-title":"Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial.","volume":"16","author":"Wachter","year":"2017","journal-title":"Lancet Neurol"},{"issue":"6","key":"noi220057r6","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/S1474-4422(21)00067-3","article-title":"Systematic monitoring for detection of atrial fibrillation in patients with acute ischaemic stroke (MonDAFIS): a randomised, open-label, multicentre study.","volume":"20","author":"Haeusler","year":"2021","journal-title":"Lancet Neurol"},{"issue":"1","key":"noi220057r7","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1161\/CIRCRESAHA.120.316341","article-title":"Population-based screening for atrial fibrillation.","volume":"127","author":"Khurshid","year":"2020","journal-title":"Circ Res"},{"issue":"10310","key":"noi220057r8","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1016\/S0140-6736(21)01698-6","article-title":"Implantable loop recorder detection of atrial fibrillation to prevent stroke (the LOOP study): a randomised controlled trial.","volume":"398","author":"Svendsen","year":"2021","journal-title":"Lancet"},{"issue":"10310","key":"noi220057r9","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1016\/S0140-6736(21)01637-8","article-title":"Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial.","volume":"398","author":"Svennberg","year":"2021","journal-title":"Lancet"},{"issue":"6","key":"noi220057r10","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1007\/s00415-009-5053-2","article-title":"Evaluation of costs and outcome in cardioembolic stroke or TIA.","volume":"256","author":"Winter","year":"2009","journal-title":"J Neurol"},{"issue":"4","key":"noi220057r11","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.022638","article-title":"Ischemic stroke severity and mortality in patients with and without atrial fibrillation.","volume":"11","author":"Vinding","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"noi220057r12","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ahj.2017.02.017","article-title":"Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): rationale and design of a large randomized controlled trial.","volume":"187","author":"Diederichsen","year":"2017","journal-title":"Am Heart J"},{"issue":"4","key":"noi220057r13","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1161\/STROKEAHA.111.000604","article-title":"National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke.","volume":"44","author":"Heldner","year":"2013","journal-title":"Stroke"},{"issue":"24 Pt 2","key":"noi220057r14","doi-asserted-by":"publisher","first-page":"2371","DOI":"10.1212\/01.wnl.0000304346.14354.0b","article-title":"Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes.","volume":"70","author":"Sato","year":"2008","journal-title":"Neurology"},{"issue":"12","key":"noi220057r15","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1136\/jnnp.54.12.1044","article-title":"The United Kingdom Transient Ischaemic Attack (UK-TIA) aspirin trial: final results.","volume":"54","author":"Farrell","year":"1991","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"noi220057r16","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial, TOAST: Trial of Org 10172 in Acute Stroke Treatment.","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"issue":"25","key":"noi220057r17","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1056\/NEJMoa1804492","article-title":"Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016.","volume":"379","author":"Feigin","year":"2018","journal-title":"N Engl J Med"},{"issue":"5","key":"noi220057r18","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/S1474-4422(19)30034-1","article-title":"Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"18","author":"Johnson","year":"2019","journal-title":"Lancet Neurol"},{"issue":"10","key":"noi220057r19","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1161\/01.STR.27.10.1765","article-title":"Acute stroke with atrial fibrillation: the Copenhagen Stroke Study.","volume":"27","author":"J\u00f8rgensen","year":"1996","journal-title":"Stroke"},{"issue":"10","key":"noi220057r20","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban vs warfarin in nonvalvular atrial fibrillation.","volume":"365","author":"Patel","year":"2011","journal-title":"N Engl J Med"},{"issue":"11","key":"noi220057r21","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban vs warfarin in patients with atrial fibrillation.","volume":"365","author":"Granger","year":"2011","journal-title":"N Engl J Med"},{"issue":"12","key":"noi220057r22","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran vs warfarin in patients with atrial fibrillation.","volume":"361","author":"Connolly","year":"2009","journal-title":"N Engl J Med"},{"issue":"20","key":"noi220057r23","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.1056\/NEJMoa1813959","article-title":"Dabigatran for prevention of stroke after embolic stroke of undetermined source.","volume":"380","author":"Diener","year":"2019","journal-title":"N Engl J Med"},{"issue":"23","key":"noi220057r24","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1056\/NEJMoa1802686","article-title":"Rivaroxaban for stroke prevention after embolic stroke of undetermined source.","volume":"378","author":"Hart","year":"2018","journal-title":"N Engl J Med"},{"issue":"4","key":"noi220057r25","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1001\/jama.2021.23732","article-title":"Screening for atrial fibrillation: US Preventive Services Task Force recommendation statement.","volume":"327","author":"Davidson","year":"2022","journal-title":"JAMA"},{"key":"noi220057r26","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.ejim.2020.09.005","article-title":"Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices, and apps: a survey of health care professionals by AF-SCREEN international collaboration.","volume":"82","author":"Boriani","year":"2020","journal-title":"Eur J Intern Med"},{"issue":"4","key":"noi220057r27","doi-asserted-by":"publisher","DOI":"10.1093\/ehjopen\/oeac044","article-title":"Screening for atrial fibrillation to prevent stroke: a meta-analysis.","volume":"2","author":"McIntyre","year":"2022","journal-title":"Eur Heart J Open"},{"issue":"11","key":"noi220057r28","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1001\/jamaneurol.2019.2167","article-title":"Effect of standard vs intensive blood pressure control on the risk of recurrent stroke: a randomized clinical trial and meta-analysis.","volume":"76","author":"Kitagawa","year":"2019","journal-title":"JAMA Neurol"},{"issue":"9","key":"noi220057r29","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1161\/HYPERTENSIONAHA.122.19333","article-title":"Systolic blood pressure and effects of screening for atrial fibrillation with long-term continuous monitoring (a LOOP substudy).","volume":"79","author":"Xing","year":"2022","journal-title":"Hypertension"},{"issue":"5","key":"noi220057r30","doi-asserted-by":"publisher","first-page":"e418","DOI":"10.1161\/STROKEAHA.109.576967","article-title":"Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants.","volume":"41","author":"Strazzullo","year":"2010","journal-title":"Stroke"},{"issue":"11","key":"noi220057r31","doi-asserted-by":"publisher","first-page":"3555","DOI":"10.1161\/STROKEAHA.120.033016","article-title":"Obesity and risk for first ischemic stroke depends on metabolic syndrome: the HUNT study.","volume":"52","author":"Horn","year":"2021","journal-title":"Stroke"},{"issue":"20","key":"noi220057r32","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1093\/eurheartj\/ehv486","article-title":"The role of obesity in atrial fibrillation.","volume":"37","author":"Nalliah","year":"2016","journal-title":"Eur Heart J"},{"issue":"2","key":"noi220057r33","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1177\/1747493018799981","article-title":"The atrial cardiopathy and antithrombotic drugs in prevention after cryptogenic stroke randomized trial: rationale and methods.","volume":"14","author":"Kamel","year":"2019","journal-title":"Int J Stroke"},{"issue":"1","key":"noi220057r34","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002433","article-title":"Stroke severity is a crucial predictor of outcome: an international prospective validation study.","volume":"5","author":"Rost","year":"2016","journal-title":"J Am Heart Assoc"},{"issue":"1","key":"noi220057r35","doi-asserted-by":"publisher","DOI":"10.1136\/bmjno-2021-000177","article-title":"Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment.","volume":"3","author":"ElHabr","year":"2021","journal-title":"BMJ Neurol Open"}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2795865\/jamaneurology_diederichsen_2022_oi_220057_1666031287.82825.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T16:00:16Z","timestamp":1764000016000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2795865"}},"subtitle":["A Post Hoc Analysis of the LOOP Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2022,10,1]]},"references-count":35,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2022.3031","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10,1]]}}}